Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma? A multicenter propensity score-matched analysis

Abstract

PurposeThe aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU).ResultsThe median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007).MethodsA total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups.ConclusionsPreoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.

The Impact of Preoperative Severe Renal Insufficiency on Poor Postsurgical Oncological Prognosis in Patients with Urothelial Carcinoma

“…Our results demonstrated that the prevalence of preoperative eGFR < 45 ml/min/1. As the prevalence of older age is higher among patients with urothelial carcinoma, studies report a recent increase in interest in the impact of preoperative renal insufficiency on poor prognosis [13][14][15]24,25]. Several studies have indicated an association between chronic kidney disease (CKD) and oncological outcomes associated with the effects of chronic inflammation, oxidative stress, metabolic disorder, uraemiaassociated immune deficiency, and frailty [26][27][28].…”

Chronic kidney disease and positive surgical margins as prognosticators for upper urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy

“…The present study also revealed that inflammatory markers such NLR and PLR were related to poor prognosis in univariate analysis, but not in multivariate analysis, although eGFR <60 ml/min/1.73 m 2 was found to be significantly associated with worse disease-specific and recurrence-free survival rates in patients with UTUC who underwent radical nephroureterectomy in multivariate analysis. In addition, others suggested CKD or end-stage renal disease may be involved in the progression or aggressiveness of UTUC, i.e., decreasing disease-specific and/or recurrence-free survival (27)(28)(29). Another study has suggested that UTUC patients with CKD undergoing hemodialysis lack the immune cells that recognize the tumor-associated antigens, thereby resulting in the acceptance of tumor progression under the status of immunological suppression (30).…”

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

“…Patients with renal impairment are at risk of CVD [14], but the reason for the strong association between CKD and poor recurrence-free survival is not clear. Previous studies suggested kidney and urinary tract cancers are high risk for renal dysfunction due to the tumor location (obstruction, and/or reduction of nephron mass) [13,[15][16][17]. The prevalence of CKD in genitourinary cancers were reported 8.7-21.4% [15,18].…”